Brain death in children: a retrospective review of patients at a paediatric intensive care unit.

PURPOSE: Among patients in paediatric intensive care units (PICUs), death is sometimes inevitable despite advances in treatment. Some PICU patients may have irreversible cessation of all brain function, which is considered as brain death (BD). This study investigated demographic and clinical differences between PICU patients with BD and those with cardiopulmonary death. METHODS: All children who died in the PICU at a university-affiliated trauma centre between October 2002 and October 2018 were included in this retrospective study. Demographics and clinical characteristics were compared between patients with BD and patients with cardiopulmonary death. RESULTS: Of the 2784 patients admitted to the PICU during the study period, 127 died (4.6%). Of these 127 deaths, 22 (17.3%) were BD and 105 were cardiopulmonary death. Length of PICU stay was shorter for patients with cardiopulmonary death than for patients with BD (2 vs 8.5 days, P=0.0042). The most common mechanisms of injury in patients with BD were hypoxic-ischaemic injury (40.9%), central nervous system infection (18.2%), and traumatic brain injury (13.6%). The combined proportion of accident and trauma-related injury was greater in patients with BD than in patients with cardiopulmonary death (27.3% vs 3.8%, P<0.001). Organ donation was approved by the families of four of the 22 patients with BD (18.2%) and was performed successfully in three of these four patients. CONCLUSIONS: These findings emphasise the importance of injury prevention in childhood, as well as the need for education of the public regarding acceptance of BD and support for organ donation.

Different types of visual cells in the photoreceptor layer of the retinae of the treeshrew (Tupaia belangeri chinensis) as revealed by scanning microscopy.

BACKGROUND: The retinae of treeshrew have never been evaluated by scanning electron microscopic studies. MATERIALS AND METHODS: This work described the visual cells in the photoreceptor layer of the retinae of treeshrew (Tupaia belangeri chinensis) living on the high plateau of Yunnan, China, via scanning electron microscopy. RESULTS: Results indicated five morphologically different types of cones, two of which contain oil droplets in their inner segments. To our knowledge, no prior studies have reported oil droplets in the visual cells of higher mammals, only in lower vertebrate and primitive mammals. In addition, this study revealed one type of degenerative visual cell without outer segments. CONCLUSIONS: The findings signal the needs for additional studies to understand the physiological functions and phylogenetic relationships of the diversity of visual cells in this group of mammal.

A novel mitochondrial DNA deletion in a Chinese girl with Kearns-Sayre syndrome.

Kearns-Sayre syndrome is a rare disorder often caused by mitochondrial DNA rearrangement. The most commonly reported mitochondrial DNA deletion is 4977 bp in size spanning nucleotides 8469 and 13447. The clinical signs of Kearns-Sayre syndrome include chronic progressive external ophthalmoplegia, retinitis pigmentosa, heart block and cerebellar ataxia, as well as other heterogeneous manifestations including neuromuscular problems and endocrine disorders. Cardiac conduction defects can develop insidiously, leading to sudden death sometimes if not promptly recognised. This report focuses on the diagnosis of Kearns-Sayre syndrome in a Chinese girl who presented initially with short stature, delayed puberty, insidious onset of ptosis and later with typical features of Kearns-Sayre syndrome including complete heart block. Genetic analysis disclosed a novel 7.2 kilobases deletion in muscle tissue. Mitochondrial diseases have heterogeneous phenotypes and mutational analysis has proven to be an effective tool for confirming the diagnosis.

Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate.

Fractures associated with osteoporosis are common among elderly people and postmenopausal women. Bisphosphonate is an effective anti-resorptive drug commonly used for the prevention and treatment of osteoporosis. There are, however, concerns about potential side-effects during long-term treatment with alendronate. We report a case where an 82-year-old woman who had been taking alendronate for 10 years presented with two episodes of non-traumatic femoral shaft fracture. An iliac bone biopsy showed severely suppressed bone turnover, suggestive of adynamic bone disease. We suspect the bone turnover suppression was related to the prolonged use of alendronate.

Fetal echocardiography: results in high-risk patients.

The results of 140 fetal cardiac scans in 124 high-risk obstetric patients (16 to 40 weeks' gestation) are presented. Sixty patients were scanned for high genetic or environmental risk (group 1); 31 because of fetal abnormality detected on routine ultrasound scanning (group 2) and 37 because of arrhythmias (group 3). Three patients were in two groups. The standard echocardiography views, ie, long-axis, great vessel short axis, four chamber, and aortic arch were obtained in 72, 95, 96, and 55%, respectively. All scans in group 1 were diagnosed as normal. In group 2, complex cardiac abnormalities were detected, the presence of fetal cardiac failure and its cause were clarified, and serious cardiac malformations were excluded. Arrhythmias in group 3 were diagnosed correctly and fetal hemodynamics assessed. A small number of lesions were not detected or diagnosed. The factors interfering with detection of lesions were abnormalities of the intrathoracic or abdominal cavity, inadequate amniotic fluid, and size of lesions. Major cardiac structures or abnormalities could be identified, and abnormal hemodynamics caused by arrhythmias and structural lesions assessed. Unnecessary intervention was prevented in five cases and conversely the need for acute intervention was indicated in seven cases. Fetal echocardiography remains a specialized investigation that has an important role in the management of some high-risk pregnancies.

Clear cell chondrosarcoma: case report and ultrastructural study.

A case of clear cell chondrosarcoma in a Chinese patient is described. The clear cells showed strongly positive S-100 protein immunoreactivity. Ultrastructurally 2 types of chondroid cells were demonstrated. One type appeared more primitive with abundant electron-lucent cytoplasm and sparse organelles. The other type of cell was more differentiated with presence of microvilli and numerous dilated cisternae of endoplasmic reticulum. Previous ultrastructural studies on these lesions were reviewed and compared with the present findings.

Use of low molecular weight heparin in postangioplasty management.

The results of using low molecular weight heparin (LMWH) in postangioplasty management are examined. In comparison to intravenous unfractionated heparin, subcutaneous LMWH caused less groin complications and was simpler and cheaper to be administered by the medical personnel. The incidence of ischaemic complications after angioplasty including acute closure and myocardial infarction, however, remained similar and was not excessive. Subcutaneous administration of LMWH provides and alternative simple and cost-effective strategy for postangioplasty management.

Balloon mitral commissurotomy in a patient with situs inversus and dextrocardia.

A patient with situs inversus and dextrocardia in whom a successful balloon mitral commissurotomy for symptomatic rheumatic mitral stenosis was performed after appropriate modifications in the technique of transseptal catheterization is described.

Percutaneous mitral balloon valvotomy in a patient with coexistent mitral stenosis and hypertrophic cardiomyopathy.

A patient with coexistent mitral stenosis and hypertrophic cardiomyopathy is described, in whom symptoms related to impaired left ventricular diastolic filling improved after successful percutaneous mitral balloon valvotomy.

Inoue balloon pericardiotomy for patients with recurrent pericardial effusion.

The results and follow-up data for 11 patients with recurrent effusion due to various etiologies who underwent balloon pericardiotomy with the Inoue balloon catheter between May 1992 and July 1994 are described. Inoue balloon pericardiotomy was successful in 10 patients (91%), who remained free of pericardial effusion at a mean follow-up duration of 4.2 months. All patients tolerated the procedure well with minimal discomfort and with no complications. Despite good symptomatic relief, 9 patients (82%) eventually succumbed to disease dissemination, with a mean survival time of 1.4 months. It is concluded that Inoue balloon pericardiotomy is a safe and useful alternative to surgical pericardial windowing for the symptomatic treatment of recurrent pericardial effusion.

Classic late infantile neuronal ceroid lipofuscinosis in a Chinese patient.

Neuronal ceroid lipofuscinoses are a group of rare neurodegenerative disorders that are characterised by an accumulation of autofluorescent lipopigments in neurons and extraneuronal tissues. We report on a 4-year-old boy who presented with an acute onset of seizures followed by rapid psychomotor deterioration, ataxia, and visual failure. Photic stimulation at 1 to 3 Hz elicited discrete spike and wave discharges in the electroencephalogram, which were diminished at a higher frequency of stimulation. The electroretinogram was extinct. Magnetic resonance imaging of the brain showed generalised cerebral and cerebellar atrophy. Electron microscopic examination of lymphocytes and samples of muscle and skin revealed characteristic curvilinear inclusion bodies. To our knowledge, this is the first case of late infantile neuronal ceroid lipofuscinosis to be reported in a Hong Kong Chinese patient.

Respiratory insufficiency in a Chinese adult with mitochondrial myopathy.

Mitochondrial myopathy is an important but uncommon cause of respiratory insufficiency in adults. We report the first case of respiratory insufficiency associated with adult-onset mitochondrial myopathy seen in a Chinese adult in Hong Kong. The patient presented with peripheral oedema and shortness of breath over 2 to 3 days. There was a history of gradual progressive limb weakness over approximately 2 years, hypertrophic cardiomyopathy, intermittent diarrhoea, and weight loss. The diagnosis was made by skeletal muscle biopsy and molecular study, which revealed the A3243G point mutation.

[The influence of small dose intrathecal fentanyl on shivering during transurethral resection of prostate under spinal anesthesia].

Shivering during spinal anesthesia is a common complication in patients undergoing transurethral resection of prostate. The high incidence of shivering may be due to decreased core temperature secondary to peripheral vasodilation from sympathetic blockade and/or cold irrigation fluid. Shivering is known to increase O2 consumption, ventilation and cardiac output, which can result in morbidity to patients with limited cardiopulmonary reserves. The aim of this randomized double-blind study was to investigate whether 1.25 micrograms of intrathecal fentanyl administered would influence the incidence and severity of shivering in patients who underwent TURP under spinal anesthesia. In the present study, 79 patients with (n = 41) or without (n = 38) low dose fentanyl were study. The incidence of shivering was 65.8% in control group and 12.2% in the study group. The difference was statistical significance. The shivering grade (1.0 +/- 0 vs 1.76 +/- 0.7) and accumulative shivering scores (2.4 +/- 0.8 vs 12.5 +/- 5.6) were also significantly decreased in the study group (P < 0.05). Obviously, there was no difference in the incidence of pharmacologic side effect. We concluded that low dose intrathecal fentanyl is a god method for decreasing both incidence and severity of shivering during spinal anesthesia.

Experience of anesthesia for transthoracic endoscopic sympathectomy in palmar hyperhidrosis--110 cases.

Transthoracic endoscopic sympathectomy (TES) is an effective treatment for palmar hyperhidrosis. We review our experience and discuss the anesthetic technique and perioperative complications encountered in 110 patients undergoing TES for palmar hyperhidrosis. All patients were monitored with EKG, NIBP and pulse oximetry (SPO2) during the operation. The trachea was intubated with a single lumen endotracheal tube and ventilation was controlled manually. 100% inspired oxygen was necessary during TES to avoid hypoxia. One patient developed sudden cardiac arrest during electrocauterization of the left sympathetic chain and two patients required underwater drainage for hemothorax. Minimal pneumothorax was diagnosed in 4 patients and all cases resolved spontaneously without active treatment.